article

The Day Castro Wept

In an exclusive excerpt from her new book, Without Fidel, Ann Louise Bardach penetrates the wall of secrecy around the Castro family and reveals the close calls during Fidel’s medical crisis.

•Castro does not have colon cancer, as was rumored, but “malignant diverticulitis,” which can be an equally dangerous illness.

•In July 2006, Castro rejected the recommended surgery and insisted on a riskier, more radical surgery that failed, almost costing him his life.

•When a second, life-saving surgery necessitated a colostomy, he wept.

•Castro’s son Antonio told friends in 2006, “What my old man has is insurmoutable.”

•Around the time of these surgeries, according to a prominent Swiss banker, some of Cuba’s accounts were transferred to an undisclosed signatory, most likely Raul Castro.

•For five months after the surgeries, Castro was fed intravenously and lost 45 pounds. He has since stabilized with the help of a highly restrictive diet and the use of a state-of-the-art hyperbaric oxygen chamber.

•In one of his frequent opinion columns for Granma, Castro wrote in late 2008 that he did not expect to live to see the end of Obama’s term.

The dying began on July 27, 2006—and it has yet to end. Certainly, it would have been hard to imagine a final coda less appealing to Fidel Castro—a proud and prudish man who has zealously guarded his personal privacy. For Castro, an obsessive autocrat and micro-manager, nothing could have been more distressing than to see details of his emergency intestinal surgery splayed across the front pages of newspapers and Web sites five months later. For the first time, Fidel Castro had been sidelined as the master of his own fate. A new portrait—that of a frail octogenarian clinging to life—supplanted his carefully crafted persona of the vigilant warrior.

But as befitted a movie-star dictator—and the world’s longest-reigning head of state—Castro would take his time leaving the stage. That exit, with periodic finales, is fated to be a marathon: an epic that one might be tempted to call
The Fideliad.

Without Fidel: A Death Foretold in Miami, Havana, and Washington. By Ann Louise Bardach. 352 pages. Scribner. $30. ()

On July 26, 2006, Castro had participated in the usual anniversary celebrations of the Cuban Revolution. But as the day wore on, El Comandante was visibly piqued and coughing, in crippling pain. “I thought that would be the end of it,” he later reflected. Hours later, he was flown back to Havana and rushed to Cuba’s foremost medical facility. A week earlier in Argentina, Castro had sparred with a Cuban-American reporter who questioned him about a dissident denied a visa to leave Cuba. An enraged Castro had erupted into a lightning tirade, captured on videotape.

After he fell ill, one source close to Castro’s doctors speculated that the stressful encounter had precipitated a furious new bout of diverticulitis. This painful, recurrent intestinal infection had dogged Castro since the 1970s and reportedly first required surgery in the 1980s. Diverticulosis is a relatively common symptom of aging characterized by outpouchings—or diverticula—in the lining of the colon or large intestine. When the diverticula become infected, bleed or rupture, the so-called diverticulitis can be exceedingly painful and potentially life threatening.

Castro almost certainly suffered from the most severe variant of this disease, known in some medical circles as “malignant diverticulitis.” It is not technically cancer, but it often has a similar progression, with comparable mortality rates. “This form of the disease pursues a relentless course of chronic sepsis, recurrent fistulization and eventual death due to one or more complications of the disease,” according to one medical paper written on the subject. Castro’s handlers could truthfully deny the persistent rumor that he had colon cancer, yet his illness, which cascaded into multiple complications, was equally challenging.

For three days in July 2006, the news blackout was in eerie counterpoint to the squads of government officials seen scurrying between the offices of the Central Committee of the Communist Party and the Palace of the Revolution. On July 28, Castro’s primary-care physician—accompanied by state security officals—was seen rushing into the palace. The unsettling silence broke dramatically on July 31, when the nightly newscast cut away to Castro’s faithful personal assistant (since sidelined) Carlos Valenciaga. He read a prepared statement, purportedly written by Fidel, that said he had undergone “an acute intestinal crisis with sustained bleeding that has obliged me to undergo a complicated surgical operation.” The missive went on to declare a temporary transfer of power to to his 75-year-old brother, Raúl, the head of the Armed Forces.

Many among the elite, chattering class of Havana, known as the
nomenklatura, were convinced that the Comandante had met his maker. They were not alone. A prominent Geneva banker on the board of the banking behemoth UBS, with firsthand knowledge of Cuba’s numbered Swiss bank accounts, was likewise convinced that Castro had died. Some of Cuba’s funds have long been handled by the Geneva branch of Handelsfinanz—later bought by HSBC Guyerzeller. “He’s a cadaver,” the banker told a confidant, noting that government funds, controlled by Castro, had been transferred, presumably to his brother Raúl, during the final days of July 2006.

Miguel Brugeras, who had served as Cuba’s ambassador to Lebanon, Argentina, and Panama, was among those allowed to visit with Castro in those early weeks. A devout
fidelista, Brugeras told close friends that “Fidel will not recover from this.” Castro did not have cancer, he said, but his condition was nonetheless “terminal.” (Ironically, Brugeras would die within the year, while Castro soldiered on from his hospital suite.)

In Havana, rumors of Fidel’s passing were quelled only when two of his sons showed up in mid-August 2006 at a high-profile party for a well-known artist. Not long after, his son Antonio Castro, an orthopedic surgeon who heads up Cuba’s national baseball league and who is the personal doctor for his uncle Raul, thanked a colleague for his condolences, adding sadly, “Lo que el Viejo tiene—es fulminante.” “What my old man has—is insurmountable.”

By late October 2006, rumors that Fidel had slipped from his mortal coil were so pervasive that the government arranged for taped footage of a frail Castro to be shown on television. Family members fretted to trusted friends that he had dropped more than 45 pounds and was still not able to sit up or eat solid food.

Then quite suddenly, the hermetically sealed bubble around Castro was punctured. On Christmas Eve 2006, a Barcelona newspaper broke the story of a secret trip to Havana by Spanish surgeon José Luis García Sabrido, a colon-cancer specialist who had previously treated Castro. Three weeks later, on January 16, 2007, the Spanish daily El País published a bombshell account of Castro’s condition based on two medical sources who worked at the same hospital as Dr. García Sabrido. It reported that in July Castro had barely survived three bungled intestinal surgeries and suffered two bouts of peritonitis, a potentially life-threatening infection.

As it turned out, Castro’s medical crisis had been largely one of his own making. Typically, a patient with Castro’s history of chronic and acute diverticulitis would have a colostomy, which involves cutting out the infected segments of intestine, and then attaching an external bag to the patient. Once the patient has fully recovered, a second surgery is necessary to reconnect the intestines.

But Castro nixed having a colostomy, perhaps out of pride, machismo, or hubris—or some combination of the three. Hoping to avoid a second surgery, he decided upon a far bolder operation. Despite warnings of the risk involved, Castro opted for a surgery in which infected portions of the colon were removed and the colon was reconnected at the same time. Under these circumstances, “attempted resection is fraught with difficulty,” warned a 1998 report by Leon Morgenstern, formerly chief of surgery at Cedars Sinai Medical Center, “and a potentially lethal outcome.” Castro’s surgeons knew this, but their patient had his own ideas. “No one could tell him no,” said a trusted friend of Castro’s, who was present at the discussions. “He would not listen to anyone because he could not bear the idea of it [the external colostomy bag].”

The shortcut—in which the colon was attached to the rectum—ruptured, leaking fecal material and causing peritonitis. An emergency second surgery was necessary. But then matters went from bad to worse. While attaching a colostomy bag, surgeons saw that Castro’s gall bladder had become gangrenous, requiring a tube to drain the toxic material. The drainage tube to the bilary duct, which connected the intestines to the gall bladder, also failed. Yet another surgery was urgently needed to insert a second drain. Castro was leaking more than a pint of fluid a day.

One UCLA colon specialist said he was not surprised by such a grim outcome: “The sepsis, lack of nutrition and systemic stress of [a failed surgery followed by peritonitis] can be quite devastating, even lethal,” he said. After a life-saving colostomy was performed, Castro was deeply distraught. “Fidel was crying,” said a source who was present in the hospital. “He cried several times that first day. He was devastated.” Castro may well have been put on dialysis, as kidney failure is not uncommon in such surgical mishaps.

For the next five months, Castro was fed intravenously. When Dr. García Sabrido arrived in December 2006, he found that “Castro was starving to death,” said documentary filmmaker Saul Landau, who spoke with a knowledgeable medical source while in Havana. “They had been feeding him only intravenously and not giving him food.” Solid food was then reintroduced into Castro’s diet and he slowly began to show signs of improvement.

Seeking to defuse rumors of the Maximum Leader’s precipitous decline, a TV segment of Hugo Chavez visiting his hospital room was arranged. Castro wore his post-operative uniform—a blousy red, white, and blue track suit that replaced his army fatigues and had the added advantage of concealing a colostomy bag. This pattern of periodic photo-ops for the convalescent in chief has continued to the present, although no live footage has been shown to date.

Castro would slide from view for weeks or months until the percolation of rumors roared to a fierce bubbling. Then, poof! he would reappear to receive the embrace of visiting sympathetic foreign leader such as Chavez, Brazil’s President Luiz Inácio Lula da Silva, or Bolivia’s President Evo Morales.

Castro also began to work the phones at odd times of the day and night, prompting some surprised recipients to refer to him as
El Fantasma—The Ghost. One Castro friend who visited him often credited the Comandante’s recovery to his use of a hyperbaric oxygen chamber: three to four times daily, said the friend, for one-hour intervals.

In January 2009, as he had so fervently hoped, Castro had lived to see the golden anniversary of the revolution he had brought to Cuba. In the spring of 2009, a seemingly rejuvenated Castro began spending more time at his Siboney home, where his doctors had created a state-of-the-art medical suite. Over the next few months, there would be the occasional sighting of Castro and his security detail around his neighborhood or near Havana’s VIP hospital, where he visited presumably for maintenance of his colostomy apparatus and possibly to have dialysis.

A few carefully selected guests were invited to visit him at his home. Three members of the Congressional Black Caucus had one such visit in April 2009, greeted by Castro’s spouse, Dalia Soto Del Valle. Rep. Bobby Rush said his group was enchanted by the Cuban leader, who remained seated during their two-hour chat. He described Castro as speaking with the trio “as though we were old family members.” When it was time for them to leave, Rush said, “he was very careful and deliberate when he stood up.”

At the end of August, Castro
spent an afternoon with director Oliver Stone, who has filmed
two sunny documentaries about the Cuban ruler for life. The Caracas-based Telesur announced last week that it will broadcast, “very soon,” a new interview with Castro by Stone; meanwhile, a Cuban government Web site said the program would show Castro “in an excellent state of health.” Stone was surprised by the announcement, according to his assistant, who emphasized that Stone “owns” the three hours of footage, which he plans to make into a documentary. “They wanted to do a Barbara Walters-type thing,” he said, referring to Walters’ flattering interview with Castro. “But we are in complete control of the footage,” adding that Stone “had not begun editing,” but hoped to have his film done by the end of the year or early next year.

Since March 2007, the Maximum Leader had been writing a “Reflections” column for the state-run daily, Granma. In staccato bursts, he has published scores of essays on topics great and small—from fulminations against George W. Bush to the pressing need to replace incandescent light bulbs with fluorescent.

In late 2008, Castro penned a favorable review of the new American president, and concluded the column on a note of somber candor. Seeking to explain his absence from the scene, he wrote that “I am well but, I insist, none of [my comrades] should feel constrained by my occasional Reflections, the gravity of my health, or my death.”

He offered further introspection. “I have had the rare privilege of observing events for a very long time. I receive information and I calmly ponder the events.” Castro then made his first public acknowledgement of the seriousness of his illness, notwithstanding his recent much-touted recovery. “I do not expect I shall enjoy such a privilege four years from now—when President Obama’s first term has concluded.”